MEDICARE: DEONTAE M COLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1992487987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEONTAE M COLE

Provider Business Mailing Address
First Line	:	1946 N 13TH ST STE 450
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-7257
Country	:	US
Telephone Number	:	419-720-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 SUNFOREST CT STE 207
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4522
Country	:	US
Telephone Number	:	419-340-5137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	03/27/2024

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Directions to “ DEONTAE M COLE ” Practice Location

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